(03HDC16282, 15 December 2004)

A 24-year-old woman complained about
the care provided to her by a midwife and an obstetrician during
her labour and delivery at a public hospital.

The woman had previously had two miscarriages, but this pregnancy
had appeared to progress well. The woman began labour mid-morning
and arrived at the hospital at 1.05pm. The labour progressed well,
and the midwife noted that the baby's condition was good. In the
early evening the independent midwife ruptured the woman's
membranes and noted "thick, mucosy cream coloured liquor". She
continued to monitor the fetal heart rate closely after noticing a
deceleration to 70bpm initially at 7.50pm. At 8.30pm there was a
prolonged deceleration to 60bpm and the obstetric consultant was
contacted.

After examining the mother and noting meconium-stained liquor
suggestive of fetal distress, the obstetrician decided to proceed
to Caesarian section. At 9.29pm an asphyxiated baby girl was
delivered with liquor thickly stained with meconium and the
umbilical cord wrapped around the neck twice. Attempts at
resuscitation were unsuccessful.

It was held that the midwife breached Rights 4(1) and 4(2) in not
monitoring the labour rigorously enough and not recording the fetal
heart rate frequently enough. The expert midwife advisor noted that
the midwife's recording was "too infrequent, poorly described and
unrelated to the contraction". The Commissioner highlighted that
"professional care requires, as a minimum, appropriately written
records, and taking and recording observations is critical to
providing a reasonable standard of care".

In addition, the poor quality of the CTG tracing and the presence
of unusual liquor should have alerted the midwife to contact the
obstetrician earlier. The midwife advisor noted that the actions
taken by the midwife after 7.50pm "lacked those critical assessment
skills necessary to judge when a labour ceases to be completely
normal".
The obstetrician was found to have acted appropriately in
delivering the baby by Caesarean section.